Wendy Diane Wilson-poth, PHD is a medicare enrolled "Psychologist - Clinical" provider in Netcong, New Jersey. Her current practice location is
111 Allen St, Netcong, New Jersey. You can reach out to her office (for appointments etc.) via phone at
(973) 527-4464.
Wendy Diane Wilson-poth is licensed to practice in Texas (license number 38218) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1912439738.
Healthcare Provider's Profile
| Full Name | Wendy Diane Wilson-poth |
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| Gender | Female |
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| Speciality | Psychologist - Clinical |
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| Location | 111 Allen St, Netcong, New Jersey |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1912439738
- Provider Enumeration Date: 03/30/2017
- Last Update Date: 12/10/2019
Medicare PECOS Information:
- PECOS PAC ID: 7911274691
- Enrollment ID: I20170531000872
Medical Identifiers
Medical identifiers for Wendy Diane Wilson-poth such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1912439738 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 103TC0700X | Psychologist - Clinical | TP: 153-017 (New Jersey) | Secondary |
| 103TC0700X | Psychologist - Clinical | 38218 (Texas) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Wendy Diane Wilson-poth allows following entities to bill medicare on her behalf.
| Entity Name | Archetype Psychological Services, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1952964611
PECOS PAC ID: 7517291842
Enrollment ID: O20190620001376 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Wendy Diane Wilson-poth is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Wendy Diane Wilson-poth, PHD
111 Allen St,
Netcong, NJ 07857-1222
Ph: (973) 527-4464 | Wendy Diane Wilson-poth, PHD
111 Allen St,
Netcong, NJ 07857-1222
Ph: (973) 527-4464 |
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